Expert: Catherine Beier MS CBE - 4/17/2009

Question
Dr. Catherine,

I am overjoyed to find this discussion on vaginal birth after myomectomy.

In my situation I am debating whether or not to have a c-section and am meeting with a few other doctors to discuss my case.

I had a classical horizontal incision on the fundus and anterior wall of my uterus.  A 11cm fibroid was removed and from the post op notes it appears the surgeon may have nicked the soft pouch of the uterus (or entered the uterus).  I had my surgery 20 months prior to becoming pregnant for the first time.

My current OB office states that c-section is my only option and that they will not allow me to attempt a trial of labor since my incision was so large, deep and on the 'working part of the uterus' that does the work to push the baby out.  The risk of uterine rupture of too great.  My doctor said 'vaginal birth is better for me, c-section if better for the baby'.

I do not want to have a c-section and have another 4cm fibroid (currently)that may possibly need to be removed in the future.  I fear that c-section will lessen my chances of having more babies (I'd like 3-4 if God allows) and will increase my chances of uterine rupture in having an additional cut to the uterus.  I feel that with proper monitoring during labor and being in a facility that is prepared to do an emergency c-section I should be able to attempt the trial of labor.

Any guidance you can provide is greatly appreciated.

Answer
Tamika,


You're doing the best possible thing by seeking multiple opinions on your situation.  


A vaginal birth may be an option but it's too difficult to say at this point.  You did have a large incision in the least favorable manner, which does increase your risk of uterine rupture.

However, this risk exists during your entire pregnancy, not just birth.


So, I think the best course of action is to seek as many opinions as you can to see what options you truly have.  To find a doctor who is more supportive of vaginal birth, you may want to contact your local chapter of ICAN, the International Cesarean Awareness Network, (ican-online.org).  They can typically guide you to physicians who are less prone to high intervention births and may be able to give you more information on what options you do have in your situation.


Best,
Catherine